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PubMed2004

Promoting sexual and reproductive health and rights in Nigeria through change in medical school curriculum.

Significant developments have occurred in the field of sexual and reproductive health and rights (SRHR) globally in the last decade. However, this is yet to translate into improved status of SRHR in developing countries. One of the strategies recognised worldwide for addressing the poor status of SRHR is human capacity building at all levels. A pilot work conducted in two federal university medical schools identified a major gap in knowledge among medical students on issues related to SRHR. This called for a review of the curriculum to enable the incorporation of relevant and topical issues. This article describes the processes leading to the adoption of the Nigerian medical schools' sexual and reproductive health and rights curriculum. The exercise culminated in the identification of internal and external stakeholders and needs of the Nigerian medical schools in teaching reproductive health. The participation of lecturers (bottom-up approach) brought about a sense of ownership of the document and promoted the broad consultation and participation of all participants. It also identified capacity building and the need for evaluation as a basis for further review.

Adolescent↗
PubMed2004

Power and politics in international funding for reproductive health: the US Global Gag Rule.

Since 2001, the US government has used its power as a leading donor to family planning programmes to pursue policies in conflict with global agreements on reproductive rights. Prominent among these policies is the Mexico City Policy (or Global Gag Rule), which restricts non-governmental organisations (NGOs) in developing countries that receive USAID family planning funding from engaging in most abortion-related activities, even with their own funds. This paper reviews the history and political origins of the Gag Rule under several Republican party presidents. The Gag Rule has not achieved an overall reduction in abortions; rather, where it has disrupted family planning services, the policy is more likely to have increased the number of abortions. This paper concludes that the Gag Rule is a radical intrusion on the rights and autonomy of recipients of US funding. Regardless of whether or not it is rescinded in the future, the underlying issues in the politics of US reproductive health assistance are likely to persist. NGOs that wish to free themselves from the constraints it imposes must find the means to end their dependence on USAID funding, including turning to other donors. NGOs should also take the lead in opposing policies such as the Gag Rule that violate global agreements.

Ambulatory Care Facilities↗
PubMed2006

Coerced first sexual intercourse and selected reproductive health outcomes among young women in KwaZulu-Natal, South Africa.

Coercion may play an important role in compelling young women to engage in sexual intercourse at an early age. With a decline in age at first intercourse and increased reporting of coercive first sex, concerns of adverse reproductive health outcomes such as unintended pregnancy and sexually transmitted infections (STIs), including HIV, have become important issues, particularly in the context of a high HIV prevalence. This paper uses data collected in 2001 from the second round of a longitudinal study of 1130 sexually experienced young women in KwaZulu-Natal to investigate the relationship between coerced first intercourse and selected reproductive health outcomes and behaviours. Nearly 46% of all sexually experienced young women had reported that their first sexual encounter had been coerced. Young women who reported being coerced at first sex were significantly more likely to be Black and living in an urban area. Those who had been coerced at first sex were also more likely to report having had an STI and having experienced unintended pregnancy, than those who had not been coerced at first sex. Coercion at first sex is an important social and public health problem that has a serious impact on the reproductive health and behaviours of young women. Interventions should directly address the issue of sexual coercion by ensuring young women are aware of their reproductive rights.

Adolescent↗
PubMed1990

Genetic counseling in Catholic hospitals. Facilities must provide guidance to keep pace with new knowledge and techniques.

As advances in the knowledge of human genetics change the practice of medicine, Catholic healthcare facilities will, according to ethicists, be increasingly obliged to provide genetic counseling services to their patients. Facilities should ensure that counselors make genetic information available in a context in which no pressure, overt or subtle, is exerted to use that information in a way that may violate an individual's value system. Some hospitals may, for example, set up a separate genetic counseling department, which does not diagnose or treat genetic disorders but does facilitate access to these treatments when patients need them. Effective counseling requires accurate, current knowledge about tests and treatments, as well as about theological discussions and Church decisions on the subject. Counselors also need to be aware of some typical misconceptions people have about genetic disease. Catholic hospitals should also work with other Catholic organizations to influence legislation addressing human genetic issues, especially when such legislation addresses reproductive rights.

Catholicism↗
PubMed1990

Women--the missing persons in the AIDS epidemic. Part II.

In the Winter 1989 issue, Anastos and Marte wrote about the neglect of women in defining and treating AIDS. Women in the AIDS epidemic, they wrote, are considered mainly as vectors of transmission to men or children, not as people who are themselves HIV-infected and victims of transmission. They are predominantly women of color who, by the dictates of poverty and racism, live in communities at high risk for HIV infection. They are subjected to demeaning attitudes, poor health care services, and tragically late diagnosis in many cases. In this article the authors examine the issues of reproductive rights and HIV testing in women hospitalized for childbirth. Wendy Chavkin continues the discussion on p. 19, focusing on the efforts of AIDS prevention programs to target women solely because of their reproductive function and on the lack of services available for women who are tested.

Abortion, Legal↗
PubMed2003

Influence of working memory on patterns of motor related cortico-cortical coupling.

Working memory is implicated in various higher-order cognitive operations. We hypothesized that the availability of a temporal representation in working memory would limit the extent of cortico-cortical coupling necessary to undertake a self-paced rhythmic movement. To this end we examined modulations in cortico-cortical interactions as determined by EEG coherence during a delay interval and subsequent movement reproduction. Right hand movement was initially paced by a metronome beat every 0.9 s, followed by a delay interval, after which hand movement was repeated in an unpaced manner. Movement reproduction after a long (22.5 s, corresponding to 25 movement cycles) compared to a short (5.4 s, corresponding to 6 movement cycles) delay interval was associated with an increased degree of functional coupling in the beta frequency band (12-30 Hz) of the left (movement-driving) hemisphere (F3-FC3, F3-C3 and F3-P3 connections) as well as mesial regions (FCz-FC3, FCz-C3 and Cz-FC3 connections) even though overall behavioral characteristics were not influenced. In addition, analysis of the EEG coherence in the delay period revealed a bilateral frontal network (F3-F4, F3-FC4, F4-FC3 and FC3-FC4 connections). Activity in the latter tended to be synchronized in the theta band (4-8 Hz) and was significantly less strong at 22.5 s than 5.4 s. These data suggest that working memory may be partly subserved by synchronization in a bilateral frontal network and may provide an intrinsic contextual influence that shapes the pattern of cortico-cortical interaction during a given task.

Biomechanical Phenomena↗
PubMed2003

The energetic cost of reproductive conflicts in the ant Pachycondyla obscuricornis.

In a variety of social animals, individuals can secure reproductive rights through aggressive dominance. Direct individual benefits of aggression are widely recognized, but underlying costs affecting group productivity, and thus indirect benefits, are less clear. Costs of aggressive regulation of reproduction are especially important in small social insect colonies, where individual workers could potentially dominate male production. We estimated the energetic costs associated with the regulation of worker reproduction in the ponerine ant Pachycondyla obscuricornis, using the total CO2 emission of a colony as a measure. The level of CO2 emission of 12 experimental colonies varied significantly during five periods with varying levels of aggression and egg-laying. Overall, CO2 emission increased with the degree of fighting in a colony, but was not associated with differences in egg-laying. Aggressive regulation of reproduction and the formation of a dominance hierarchy thus pose an energetic cost to the colony. Furthermore, workers reduce their work-activities immediately after experimental orphaning, giving a further cost to the colony. These costs might influence the outcome of conflicts over male production in ants. This paper presents the first quantification of energetic costs of aggressive behavior regulating reproduction in ants.

Aggression↗
PubMed2004

Men's influences on women's reproductive health: medical anthropological perspectives.

Reproductive health has emerged as an organizational framework that incorporates men into maternal and child health (MCH) programs. For several decades, medical anthropologists have conducted reproductive health research that explores male partners' effects on women's health and the health of children. This article summarizes exemplary research in this area, showing how ethnographic studies by medical anthropologists contribute new insights to the growing public health and demographic literature on men and reproductive health. The first half of the article begins by exploring reproductive rights, examining the concept from an anthropological perspective. As part of this discussion, the question of equality versus equity is addressed, introducing anthropological perspectives on ways to incorporate men fairly into reproductive health programs and policies. The second half of the article then turns to a number of salient examples of men's relevance in the areas of contraception, abortion, pregnancy and childbirth, infertility, and fetal harm. Medical anthropological research--as well as prominent gaps in that research--is highlighted. The article concludes with thoughts on future areas of anthropological research that may improve understandings of men's influences on women's reproductive health.

Anthropology, Cultural↗
PubMed2005

A strategic assessment of the reproductive health and responsible parenthood programme of Buenos Aires, Argentina.

Since 1991, Argentina has had provincial reproductive health laws, a far-reaching national programme and strong public consensus in support of reproductive health policies. Nevertheless, the challenges of strengthening public services, increasing the number of programme sites and resisting conservative attacks remain. This article describes an assessment of the reproductive health programme of the city of Buenos Aires, passed in 2000, whose objectives are to prevent unwanted pregnancies and sexually transmitted diseases/HIV and to train health personnel. The programme operates in every public hospital and primary health care centre in the city. The assessment was conducted jointly by the Ombudsperson's Office of Buenos Aires and the Centre for the Study of State and Society (CEDES). Hormonal contraceptives, IUDs and male condoms were mostly available, but emergency contraception, female condoms and other barrier methods were not Some health professionals and service users were knowledgeable about the new laws and the reproductive rights recognised under the law. Over 90% were satisfied with quality of care in service delivery but many professionals described excessive workloads, deficient infrastructure, and shortages of supplies and staff. Wanting help to obtain a tubal ligation was the most frequent reason for the claims lodged with the Ombudsperson's Office, followed by HIV, quality of care, and abortion. Information and training for both health care providers and women's and human rights NGOs was carried out.

Adolescent↗
PubMed1997

The revival of eugenics in American popular culture.

This paper explores the possibility of a "new eugenics" from the perspective of American popular culture. Several related ideas have been expressed in recent popular sources: differential rates of reproduction among different groups are threatening the future; there are "lives not worth living"; and the threats of disability are sufficient to justify limiting reproductive rights. These beliefs draw on assumptions that the future will depend on controlling the genetic constitution of the species. Popular ideas about the powers of the gene, we argue, are laying the basis for policies controlling reproduction for the common good.

Attitude to Health↗
PubMedDate not supplied

Population policy forum. Beginning with individual women.

When IPPF was formed in 1952, its driving force was concern for women, for women's health and women's reproductive rights. 40 years on, those same issues are still at the heart of IPPF's policies and programs. Marge Berer has made a plea for a feminist approach within international family planning, and IPPF is in complete agreement that women's needs and choices should be paramount. All individuals and couples must have the basic human right to decide freely and responsible the number and spacing of their children. Women must also have the right to receive full information and counselling to choose their contraceptive method. Our secretary general, Dr. Halfdan Mahler, stresses that if family planning is to be effective, it must always begin with the individual, taking the whole issue of reproductive health into consideration. Men must share the responsibility for sexual behavior and family planning, and real equality will only be attained when women are empowered to regulate their own fertility. As nongovernmental health care organizations, IPPF's member associations offering services in 133 countries are able to work towards the principles of informed choice and voluntary family planning--even where governments may not be giving women the choices they deserve.

Behavior↗
PubMed1994

Women's health and the privatization of fertility control in Brazil.

In Brazil, privatization of the public sphere and neglect of public health is part of a conservative modernization strategy that is dominated by elite groups. The politics of human reproduction, consistent with this pattern, have left women dependent on the private sector for access to the means of fertility control, in spite of the existence of a conceptually-advanced public programme for comprehensive health care for women--a programme which expressed the demands of, and is widely supported by, the women's movement. While both the rate of contraceptive use and the types of methods used (oral contraceptives and surgical sterilization) are modern, the privatization of fertility control has resulted in a complete separation between fertility control and health care for poor women, who are the vast majority. Evidence indicates that many, perhaps most, women accumulate the health effects of totally uncontrolled and incorrect use of oral contraceptives, including unwanted pregnancies and illegal abortions, in the end resorting to clandestine surgical sterilization, which is usually performed through unnecessary caesarean section. Data on reproductive morbidity and mortality, however, are virtually non-existent. International women's reproductive rights networks and alternative services for women have advocated greater empowerment for women, in terms of improved standards of self-care and increased power in the use of health services. As a result, a gender approach to reproductive health care is now being proposed for government programmes. The Brazilian case services as an example of the limits faced by such programmes when adopted in a wider context of unfavorable political conditions.

Adult↗
PubMed1999

Women's occupational health in globalization and development.

BACKGROUND: The article describes the current process of globalization and its implications for development generally and for women, their work, and health. METHODS: The article outlines positive impacts in terms of enhancing employment opportunities in nontraditional spheres, and negative impacts in the growth of poor quality, insecure jobs with weakened social support systems. The case study of women's work within export processing zones is used to explore these conditions and their health impacts. RESULTS: The case study and other evidence provides a profile of work-related health that arises from a mix of patterns of employment, work processes, living conditions, and reproductive rights. CONCLUSIONS: The observed problems are poorly recognized, poorly studied for their combined causes and outcomes, and poorly regulated. The article explores and reviews how the patterns of female employment affect women's ability to collectively confront the causes of ill health and the challenges to improving women's occupational health in these conditions.

Africa South of the Sahara↗
PubMed2006

Basic health, women's health, and mental health among internally displaced persons in Nyala Province, South Darfur, Sudan.

OBJECTIVES: We assessed basic health, women's health, and mental health among Sudanese internally displaced persons in South Darfur. METHODS: In January 2005, we surveyed 6 registered internally displaced persons camps in Nyala District. Using systematic random sampling, we surveyed 1293 households, interviewing 1 adult female per household (N=1274); respondents' households totaled 8643 members. We inquired about respondents' mental health, opinions on women's rights, and the health status of household members. RESULTS: A majority of respondents had access to rations, shelter, and water. Sixty-eight percent (861 of 1266) used no birth control, and 53% (614 of 1147) reported at least 1 unattended birth. Thirty percent (374 of 1238) shared spousal decisions on timing and spacing of children, and 49% (503 of 1027) reported the right to refuse sex. Eighty-four percent (1043 of 1240) were circumcised. The prevalence of major depression was 31% (390 of 1253). Women also expressed limited rights regarding marriage, movement, and access to health care. Eighty-eight percent (991 of 1121) supported equal educational opportunities for women. CONCLUSIONS: Humanitarian aid has relieved a significant burden of this displaced population's basic needs. However, mental and women's health needs remain largely unmet. The findings indicate a limitation of sexual and reproductive rights that may negatively affect health.

Adolescent↗
PubMed2004

Acceptability of emergency contraception in Brazil, Chile, and Mexico. 2 - Facilitating factors versus obstacles.

A multi-center study was performed in Brazil, Chile, and Mexico to identify factors that may facilitate or hinder the introduction of emergency contraception (EC) as well as perceptions concerning emergency contraceptive pills. Background information on the socio-cultural, political, and legal context and the characteristics of reproductive health services was collected. The opinions of potential users and providers were obtained through discussion groups, and those of authorities and policymakers through semi-structured interviews. Barriers to introduction included: perception of EC as an abortifacient, opposition by the Catholic Church, limited recognition of sexual and reproductive rights, limited sex education, and insensitivity to gender issues. Facilitating factors were: perception of EC as a method that would prevent abortion and pregnancy among adolescents and rape victims; interest in the method shown by potential users as well as by some providers and authorities. It appears possible to reduce barriers through support from segments of society committed to improving sexual and reproductive health and adequate training of health care providers.

Adolescent↗
PubMed2006

Induced abortion during youth: social inequalities in the outcome of the first pregnancy.

This study aimed to identify the factors associated with induced abortion in the first pregnancy in young women and in the first time young men got their partners pregnant. The methodology was a household survey with face-to-face interviews in a probabilistic sample in three stages with 4,634 subjects, aged 18 to 24 years of age residing in the cities of Salvador, Rio de Janeiro, and Porto Alegre, Brazil. Logistic regression analysis was used with a hierarchical strategy for entering variables into the model. Abortion was the reported outcome of the first pregnancy for 16.7% of the women and 45.9% of the men (in relation to their partners). Key factors associated with abortion included higher schooling and the occasional nature of the relationship with the male or female partner in the respective pregnancy. Inclusion of males in the study provided new elements for understanding the abortion phenomenon, including in the gender issues in discussion of the theme. The authors recommend greater public investment to warrant access to information and means for young people to achieve their reproductive plans in a security and healthy way, respecting their sexual and reproductive rights.

Abortion, Induced↗
PubMedDate not supplied

Women's reproductive choices: the impact of Medicaid funding restrictions.

As of January 1997, 34 states were enforcing restrictions on Medicaid funding for abortions. Determining whether these restrictions affect women's reproductive decisions was the object of a fixed-effects log-linear analysis using 11 years of data between 1978 and 1992. Results indicate that abortion rates in states with Medicaid funding restrictions are 2% lower than rates in states with no such restrictions. However, when the supply of abortion providers and the demographic characteristics of the state population are taken into account, the difference is no longer statistically significant. Medicaid funding restrictions have no impact on birthrates, and the result is the same regardless of whether the empirical model takes into account provider availability, demographic characteristics and state sentiment toward women and reproductive rights.

Abortion, Legal↗